Provider Demographics
NPI:1356616940
Name:C & R EYE GROUP PA
Entity type:Organization
Organization Name:C & R EYE GROUP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-525-1348
Mailing Address - Street 1:4328 CENTRAL AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7436
Mailing Address - Country:US
Mailing Address - Phone:501-525-1348
Mailing Address - Fax:501-525-3723
Practice Address - Street 1:4328 CENTRAL AVE
Practice Address - Street 2:SUITE G
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7436
Practice Address - Country:US
Practice Address - Phone:501-525-1348
Practice Address - Fax:501-525-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C199Medicare PIN